Provider Demographics
NPI:1417042854
Name:MCGONIGLE, KATHRYN F (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:F
Last Name:MCGONIGLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 NW 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3025
Mailing Address - Country:US
Mailing Address - Phone:503-413-8654
Mailing Address - Fax:503-413-8655
Practice Address - Street 1:1015 NW 22ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3025
Practice Address - Country:US
Practice Address - Phone:503-413-8654
Practice Address - Fax:503-413-8655
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI743207VX0201X
ORMD204288207VX0201X
WAMD00040252207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAUS2608092OtherAETNA SPECIALIST NUMBER
WA160053987OtherRAILROAD MEDICARE
WA160053987OtherRAILROAD MEDICARE